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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Smoking is the leading preventable cause of disease&#44; disability and death&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">1&#8211;4</span></a> Smoking cessation has potentially more capacity for increasing life expectancy than any other public health measure&#46; The association between smoking and cardiovascular events is dose-dependent and increases when there are other risk factors&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">5&#44;6</span></a> Smoking cessation also leads to a reduction in the risk associated with smoking&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">7&#8211;10</span></a> However&#44; patients who smoke and experience acute coronary syndrome &#40;ACS&#41; have a better short-term prognosis than those who are not smokers&#44;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">11&#8211;16</span></a> a situation that has been described as <span class="elsevierStyleItalic">the tobacco paradox</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">17</span></a> According to this theory&#44; although an individual who smokes has a higher risk of a coronary event&#44; the survival probability in the acute moment is greater than for nonsmokers&#46;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">18&#44;19</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In this study&#44; we report the presence of the tobacco paradox in our community and attempt to explain it using other prognostic factors&#46; We also attempt to clarify the influence of the ex-smoker condition in the hospital course after presenting a coronary event&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design</span><p id="par0015" class="elsevierStylePara elsevierViewall">The SCA registry of the ARIAM-Andalusia platform is an observational&#44; prospective multicenter study of patients hospitalized in the intensive care units &#40;ICU&#41; or coronary units of hospitals in Andalusia&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">20</span></a> The data were recorded by the physicians in each center&#44; through an online computer program&#46; The software has a number of tools called <span class="elsevierStyleItalic">CoreTools</span>&#44; which provide the registry with strict quality control of the entered data&#44; applying ranges to all the variables&#44; dependence between the variables and a minimum set of recorded data&#46; This study complies with the Declaration of Helsinki and the protection of patient rights&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">21</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We analyzed a period of 11 years&#44; between January 2001 and January 2012&#44; with a total of 42&#44;827 patients belonging to 49 hospitals &#40;the complete list of centers and researchers have been previously published&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">20</span></a> Epidemiological and clinical data were collected at hospital admission&#46; Patient follow-up was conducted from admission to discharge&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Inclusion criteria</span><p id="par0025" class="elsevierStylePara elsevierViewall">The only inclusion criterion was a diagnosis of ACS&#44; with or without ST-elevation&#44; and requiring admission to the ICU&#46; The diagnosis was conducted based on the universal criteria of myocardial infarction&#46;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">22&#44;23</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Study variables</span><p id="par0030" class="elsevierStylePara elsevierViewall">The following variables were entered at admission&#58; &#40;1&#41; demographic variables such as age and sex&#59; &#40;2&#41; presence of cardiovascular risk factors&#58; smoking &#40;differentiating between active or ex-smoker&#41;&#44; diabetes mellitus&#44; hypertension&#44; dyslipidemia&#44; obesity&#44; family history of ischemic heart disease&#59; &#40;3&#41; medical history of interest&#58; prior history of angina&#44; acute myocardial infarction&#44; known coronary artery lesions&#44; heart failure&#44; stroke&#44; arrhythmias&#44; peripheral vascular disease&#44; chronic bronchial disease and renal failure&#59; and &#40;4&#41; presentation of ACS with ST-elevation or in its absence&#44; anterior location for the infarction or the presence of Killip &#8805;2 at admission&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">During the hospital course&#44; the following events were recorded&#58; reinfarction&#44; atrioventricular block or asystole&#44; ventricular tachycardia&#44; ventricular fibrillation&#44; need for mechanical ventilation&#44; shock&#44; stroke&#44; and mortality during both the ICU and hospital stay&#46; The primary assessment variable was hospital mortality&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Patients were classified into 3 groups&#58; active smokers&#44; ex-smokers and nonsmokers&#46; An ex-smoker was defined as a patient who had ceased smoking at least 3 months before their admission&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">The statistical analysis was conducted with the software package Stata 13&#46;1 &#40;Statacorp&#44; Texas&#44; USA&#44; 2013&#41;&#46; The categorical variables are presented as absolute numbers and percentages&#44; and the continuous variables are presented as means<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviations&#46; The differences in the demographic and clinical characteristics and the intrahospital events among the 3 groups &#40;smokers&#44; nonsmokers and ex-smokers&#41; were assessed with the chi-squared test for categorical variables and ANOVA for continuous variables&#44; establishing the level of statistical significance at a bilateral value of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The influence of smoking and being an ex-smoker on mortality was evaluated using two multivariate analyses&#46; First&#44; we calculated the augmented inverse probability weighting &#40;AIPW&#41;&#44; with a logistical model of weighted means&#46; The AIPW is a method that combines regression adjustment and the augmented inverse-probability weighting&#46; To confirm the results&#44; we repeated the calculation of the effect using a propensity analysis &#40;propensity matching score&#41;&#44; also with a logistical model&#46; In the Stata propensity analysis&#44; each patient was compared with another patient as similar as possible in terms of the independent variables&#44; with the only difference in the &#8220;treatment&#8221; &#40;smoker or ex-smoker&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">24&#8211;26</span></a> Both analyses were performed independently for each of the conditions&#44; smoker and ex-smoker&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In both analyses&#44; we presented the mean estimated effect in the population&#44; expressed in percentage units&#44; as a coefficient that expresses the reduction or increase in mortality&#46; As independent variables for weighting the effect of the &#8220;treatments&#8221; &#40;smoker or ex-smoker&#41; on mortality&#44; we included the clinical characteristics whose distribution was significantly different among the groups of smokers&#44; exsmokers and nonsmokers&#58; age&#44; sex&#44; elevated ST&#44; diabetes&#44; dyslipidemia&#44; arterial hypertension&#44; family history&#44; previous angina&#44; previous infarction&#44; history of heart failure&#44; stroke&#44; renal failure&#44; vasculopathy&#44; previous atrial fibrillation&#44; chronic obstructive pulmonary disease&#44; and Killip class &#8805;2 at admission &#40;<a class="elsevierStyleCrossRef" href="#sec0065">Annex 1</a>&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">Of the 42&#44;827 included patients&#44; 14&#44;285 &#40;33&#46;3&#37;&#41; were active smokers&#44; 9155 &#40;21&#46;4&#37;&#41; were exsmokers and 19&#44;387 &#40;45&#46;4&#37;&#41; were nonsmokers&#46; There were 25&#44;633 &#40;59&#46;9&#37;&#41; patients with ACS and ST elevation&#44; 16&#44;851 &#40;39&#46;3&#37;&#41; patients without ST elevation and 343 &#40;0&#46;8&#37;&#41; undefined patients&#46;</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Baseline characteristics</span><p id="par0065" class="elsevierStylePara elsevierViewall">The baseline characteristics of the patients included in the study are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Compared with the nonsmokers&#44; the patients who smoked were younger and were mostly men&#46; They also presented less comorbidity and had less personal history of ischemic heart disease&#44; heart failure&#44; arrhythmias and renal failure&#46; In contrast&#44; they had more family history of ischemic heart disease and more chronic obstructive pulmonary disease&#46; Among the smokers&#44; the most common presentation was ST-elevation and a lower frequency of a Killip class &#8805;2&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Compared with the nonsmokers&#44; the ex-smoker group was 2 years younger and mostly men&#46; They presented less diabetes&#44; hypertension and previous arrhythmias but more dyslipidemia&#44; previous infarction and angina&#44; peripheral vasculopathy&#44; renal failure&#44; chronic bronchial disease and family history of ischemic heart disease&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Hospital events</span><p id="par0075" class="elsevierStylePara elsevierViewall">In the unadjusted analysis&#44; ICU and hospital mortality was significantly higher in the nonsmoker group&#44; followed by the ex-smoker group&#44; with a lower mortality rate observed in the smokers &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Both the smokers and ex-smokers had less frequent cardiogenic shock and atrioventricular block and a lower need for mechanical ventilation&#46; The smoker group had a higher frequency of ventricular fibrillation&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The analysis of the previous smoking effect &#40;ex-smoker&#41; on mortality&#44; adjusted to the other variables&#44; showed a nonsignificant difference compared with the smokers&#44; both with the inverse probability analysis and the propensity analysis&#44; with a difference in mortality in the population of &#8722;0&#46;3&#37; and &#43;0&#46;4&#37;&#44; respectively&#46; In contrast&#44; being an ex-smoker resulted in a significant reduction in mortality in both tests&#59; 2&#46;2&#37; in the inverse probability analysis &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and 2&#46;1&#37; in the propensity analysis &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;005&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">Numerous studies have demonstrated the association between smoking and cardiovascular morbidity&#44; including an increase in the risk of an acute coronary event and sudden cardiac death&#46;<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">27&#8211;29</span></a> Additionally&#44; smoking cessation has been associated with a significant reduction in all-cause mortality in patients with ischemic heart disease&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">10</span></a> However&#44; in patients with ACS&#44; various studies have observed that smokers have a better prognosis than nonsmokers&#46; Several explanations have been proposed to clarify this paradox&#44; including a younger age&#44; a lighter burden of associated comorbidities and a lesser extent of coronary artery lesions in patients who smoke&#46;<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">30&#44;31</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Age is the most significant short-term prognostic factor in ACS&#46;<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">32&#8211;35</span></a> Nevertheless&#44; in a study that assessed the tobacco paradox among young patients with ACS&#44; those who were smokers had greater hospital mortality and mortality at 8 months than the nonsmoker group&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">36</span></a> This finding differs from other studies in which&#44; after adjusting for age using multivariate analysis between the 2 groups&#44; this supposed prognostic factor observed among the smokers disappeared completely&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">12&#8211;15</span></a> These discrepancies among the studies could be due to methodological differences&#44; such as patient selection&#44; sample size and the variables included in the multivariate analysis&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In our registry&#44; we also observed a lower age among the smoker group&#46; This difference in age could partially explain the lower mortality rate in this group&#44; given that when the groups&#8217; baseline characteristics were corrected for other prognosis-related factors&#44; the protective effect of smoking disappeared&#46; However&#44; in a logistic regression analysis that included multiple covariates previously published by the ARIAM Group&#44; prior smoking continued to be &#8220;protective&#8221; in the short-term&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">37</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Barbash et al&#46; studied 2400 patients recruited for the angiographic substudy of GUSTO-I and demonstrated that the smokers had a lower rate of multivessel impairment&#44; while experiencing more infarctions whose responsible artery was the right coronary than the nonsmokers&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">20</span></a> Accordingly&#44; the data from other angiographic and epidemiologic studies suggest that acute myocardial infarction in smokers occurs in a relatively early period of the coronary atherosclerosis process&#46; The hypercoagulability associated with active smokers due to increases in hematocrit&#44; fibrinogen and thrombin&#44; as well as greater platelet activation&#44; have been proposed as an explanation for the prognostic differences in smokers&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">12&#44;31</span></a> The accumulated evidence supports the contention that myocardial infarction in smokers occurs on less severe lesions than in nonsmokers&#44; with a predominant thrombogenic mechanism&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">31</span></a> This could explain the better response to thrombolytic treatment that has also been reported in previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">14&#44;19&#44;31&#44;38</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The interaction between clopidogrel and tobacco has recently been investigated&#46; Smoking has been shown to induce cytochrome P4501A2&#44; causing an improvement in the response to clopidogrel in smokers&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">39</span></a> The Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization&#44; Management and Avoidance &#40;CHARISMA&#41; study compared 75<span class="elsevierStyleHsp" style=""></span>mg clopidogrel per day versus placebo in patients with high-risk profiles&#44; showing a significant reduction in mortality in smokers&#44; without achieving this effect in nonsmokers&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">40</span></a> The Clopidogrel as Adjunctive Reperfusion Therapy-Thrombolysis in Myocardial Infarction 28 &#40;CLARITY-TIMI 28&#41; trial compared the effect of clopidogrel with angiographic and clinical variables in patients with ACS and ST elevation&#46; The trial showed that the antiplatelet agent was significantly more effective in reducing the rate of cardiovascular death&#44; myocardial infarction and emergency revascularization among patients who smoke&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">41</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">An earlier marker peak has also been reported among smokers after presenting an acute coronary event&#44; which could be related to a lesser involvement of the coronary microcirculation&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">42</span></a> This theory could be supported by the fact that a lower resolution of the ST-segment after reperfusion has been observed in patients with ACS and ST elevation with no history of smoking&#46;<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">43&#44;44</span></a> Heeschen et al&#46; reported a greater development of collateral coronary circulation after the administration of nicotine to mice in an animal model&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">45</span></a> Similarly&#44; Ruixing et al&#46; showed the ability of an intramuscular administration of nicotine to promote intramyocardial angiogenesis&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">46</span></a> Therefore&#44; smoking could increase the collateral coronary circulation and prevent damage to the microcirculation following reperfusion therapy&#46; This could explain why there are fewer patients with heart failure during the follow-up in the smoker group&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">As with our study&#44; several studies have confirmed that the protective effect of smoking on ACS is explained by other prognostic variables&#46;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">13&#44;15&#44;47</span></a> In this study&#44; we applied a new and powerful methodology of multivariate analysis&#44; with a propensity study that included all patients in the calculation of the effect of smoking on mortality&#46; This showed which the covariates did explain this apparent paradox in the case of active smokers&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Another conclusion that we can extract from our study is that the prognosis of a patient with ACS is better for those who have ceased smoking&#44; as has been observed in other previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">10&#44;48</span></a> However&#44; the pathophysiological basis of this beneficial effect is not known&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">49</span></a> It has been postulated that prior smoking cessation is associated with a reduction in platelet size<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">49</span></a> and with an increase in adiponectin levels&#44;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">50</span></a> which could result in better progress for the ACS after ceasing to smoke&#46; Numerous studies have reported the beneficial effect of smoking cessation among the general population and in patients with a history of ischemic heart disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">10&#44;51&#44;52</span></a> Moreover&#44; van Berkel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">53</span></a> reviewed the published data on the impact of smoking cessation and found that the relative risk of mortality among exsmokers and active smokers varied between 0&#46;13 and 0&#46;72&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">After a significant number of variables that differentiated smokers from nonsmokers hospitalized for ACS were included in our study&#39;s multivariate analysis&#44; smoking had no protective effect&#46; In contrast&#44; prior smoking cessation did have a significant influence&#44; with a reduction in mortality in the study population of more than 1&#46;5&#37; in absolute terms&#46; Therefore&#44; as indicated by Andrikopoulos et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">13</span></a> the term tobacco paradox should be avoided because there is no real paradox&#44; and its use could induce the general population into the incorrect assumption of a benefit from tobacco in the context of ACS&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">This study has a number of limitations&#46; Although the ARIAM registry is designed to include all patients admitted to ICUs&#44; each case is manually entered and therefore depends on researcher intent&#44; which coupled with the requirement of being admitted to the ICU&#44; could introduce patient selection biases&#46; Our study has the limitations of all observational registries&#46; The applied statistical methodology is a version of the multivariate and propensity analysis of considerable power&#44; which uses information from all patients to approximate the result of an experimental model but is based on mathematical estimates using the included variables&#46; We cannot ensure that there are other variables not included in the study that could significantly alter the results&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In summary&#44; the tobacco paradox in patients admitted for ACS is a finding that could be explained by adjusting the baseline characteristics by other prognostic factors&#46; Prior smoking cessation is associated with a better prognosis when the patient is admitted for an ACS&#46; Therefore&#44; we should emphasize the importance of preventing this noxious habit in the general population and of achieving smoking cessation among active smokers&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The tobacco paradox is a phenomenon insufficiently explained by previous studies&#46; This study analyses the prognostic role of prior or active smoking in patients with acute coronary syndrome&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We obtained data from the ARIAM registry&#44; between 2001 and 2012&#46; The study included 42&#44;827 patients with acute coronary syndrome &#40;mean age&#44; 65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13 years&#59; 26&#46;4&#37; women&#41;&#46; The influence of smoking and that of being an ex-smoker on mortality was analysed using a multivariate analysis&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The smokers were younger&#44; were more often men&#44; had less diabetes&#44; hypertension and prior history of heart failure&#44; stroke&#44; arrhythmia and renal failure and more frequently had ST-elevation and a family history of smoking&#46; The ex-smokers had more dyslipidaemia and history of angina&#44; myocardial infarction&#44; ischemic heart disease&#44; peripheral vasculopathy and chronic bronchial disease&#46; Smokers and ex-smokers less frequently developed cardiogenic shock &#40;smokers 4&#46;2&#37;&#44; ex-smokers 4&#46;7&#37; and nonsmokers 6&#46;9&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Hospital mortality was 7&#46;8&#37; for the nonsmokers&#44; 4&#46;9&#37; for the ex-smokers and 3&#46;1&#37; for the smokers <span class="elsevierStyleItalic">&#40;p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; In the multivariate analysis&#44; the smoker factor lost its influence in the prognosis &#40;&#8211;0&#46;26&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;52 using an inverse probability calculation&#59; and &#43;0&#46;26&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;691 using a propensity analysis&#41;&#46; However&#44; the exsmoker factor showed a significant reduction in mortality in both tests &#40;&#8211;2&#46;4&#37; in the inverse probability analysis&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#59; and &#8211;1&#46;5&#37; in the propensity analysis&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;005&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The tobacco paradox is a finding that could be explained by other prognostic factors&#46; Smoking cessation prior to hospitalization for acute coronary syndrome is associated with a better prognosis&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La paradoja del tabaco es un fen&#243;meno insuficientemente explicado en estudios previos&#46; Este estudio analiza el papel pron&#243;stico del tabaquismo previo o activo en pacientes con s&#237;ndrome coronario agudo&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Obtuvimos los datos del registro ARIAM&#44; entre 2001 y 2012&#46; Se incluy&#243; a 42&#46;827 pacientes con s&#237;ndrome coronario agudo &#40;edad media 65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13 a&#241;os&#44; 26&#44;4&#37; mujeres&#41;&#46; Se analiz&#243; la influencia del h&#225;bito tab&#225;quico o de la condici&#243;n de exfumador en la mortalidad mediante an&#225;lisis multivariados&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Los fumadores eran m&#225;s j&#243;venes&#44; m&#225;s frecuentemente hombres&#44; ten&#237;an menos diabetes&#44; hipertensi&#243;n e historia previa de insuficiencia cardiaca&#44; ictus&#44; arritmia e insuficiencia renal&#44; as&#237; como m&#225;s frecuentemente elevaci&#243;n del ST e historia familiar&#46; Los exfumadores presentaban m&#225;s dislipidemia e historia de angina&#44; infarto de miocardio&#44; cardiopat&#237;a isqu&#233;mica&#44; vasculopat&#237;a perif&#233;rica y broncopat&#237;a cr&#243;nica&#46; Fumadores y exfumadores desarrollaron menos frecuentemente shock cardiog&#233;nico &#40;fumadores 4&#44;2&#37;&#44; exfumadores 4&#44;7&#37; y no fumadores 6&#44;9&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; La mortalidad hospitalaria fue del 7&#44;8&#37; en los no fumadores&#44; un 4&#44;9&#37; en los exfumadores y un 3&#44;1&#37; en los fumadores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; En el an&#225;lisis multivariado&#44; el car&#225;cter fumador perdi&#243; su influencia en el pron&#243;stico &#40;&#8211;0&#44;26&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;52 mediante c&#225;lculo de probabilidad inversa&#59; y &#43;0&#44;26&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;691 mediante an&#225;lisis de propensi&#243;n&#41;&#46; Sin embargo&#44; el car&#225;cter exfumador mostr&#243; una reducci&#243;n significativa de la mortalidad en ambos test &#40;&#8211;2&#44;4&#37; en el an&#225;lisis de probabilidad inversa&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; y &#8211;1&#44;5&#37; en el an&#225;lisis de propensi&#243;n&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La paradoja del tabaco es un hallazgo que puede explicarse por otros factores pron&#243;sticos&#46; El abandono del h&#225;bito tab&#225;quico previo a un ingreso por s&#237;ndrome coronario agudo se asocia a un mejor pron&#243;stico&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Please cite this article as&#58; Bastos-Amador P&#44; Almendro-Delia M&#44; Mu&#241;oz-Calero B&#44; Blanco-Ponce E&#44; Recio-Mayoral A&#44; Reina-Toral A&#44; et al&#46; La paradoja del tabaco en el s&#237;ndrome coronario agudo&#46; El abandono previo del h&#225;bito tab&#225;quico como marcador de mejor pron&#243;stico a corto plazo&#46; Rev Clin Esp&#46; 2016&#59;216&#58;301&#8211;307&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0150" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;</p> <p id="par0155" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0065"
          ]
        ]
      ]
    ]
    "multimedia" => array:5 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; SD&#44; standard deviation&#59; AHT&#44; arterial hypertension&#59; AMI&#44; acute myocardial infarction&#59; HF&#44; heart failure&#59; COPD&#44; chronic obstructive pulmonary disease&#59; RF&#44; renal failure&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ex-smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Nonsmokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Demographic characteristics</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#44;285&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9155&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#44;387&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female sex&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1339 &#40;9&#46;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">314 &#40;3&#46;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9655 &#40;49&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Age&#44; years <span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;4<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;8<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Cardiovascular risk factors</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2900 &#40;20&#46;3&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3111 &#40;34&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7779 &#40;40&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dyslipidemia&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5288 &#40;37&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4032 &#40;44&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7441 &#40;38&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>AHT&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5423 &#40;38&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5050 &#40;55&#46;2&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#44;977 &#40;61&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Obesity&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1595 &#40;11&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1035 &#40;11&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2104 &#40;10&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;456&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Family history&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1859 &#40;13&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">773 &#40;8&#46;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1335 &#40;6&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">History</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Angina&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2468 &#40;17&#46;3&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2813 &#40;30&#46;7&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5077 &#40;26&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>AMI&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1642 &#40;11&#46;5&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2544 &#40;27&#46;8&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3380 &#40;17&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Coronary lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">513 &#40;3&#46;6&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">831 &#40;9&#46;1&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1139 &#40;5&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HF&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">245 &#40;1&#46;7&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">577 &#40;6&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1159 &#40;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Stroke&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">464 &#40;3&#46;2&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">596 &#40;6&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1336 &#40;6&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Arrhythmia&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">337 &#40;2&#46;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">663 &#40;7&#46;2&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1598 &#40;8&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vasculopathy&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">635 &#40;4&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">767 &#40;8&#46;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">778 &#40;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>COPD&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">593 &#40;4&#46;2&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">728 &#40;8&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">501 &#40;2&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>RF&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">111 &#40;0&#46;8&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">226 &#40;2&#46;5&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">393 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Presentation</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Elevated ST-segment&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9921 &#40;70&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4949 &#40;55&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;763 &#40;56&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Killip<span class="elsevierStyleHsp" style=""></span>&#62;2 at admission&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2090 &#40;15&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2002 &#40;22&#46;7&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4980 &#40;26&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; AVB&#44; atrioventricular block&#59; ICU&#44; intensive care unit&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Smokers<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#44;285&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ex-smokers<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9155&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Nonsmokers<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#44;387&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Reinfarction&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">293 &#40;2&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">226 &#40;2&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">455 &#40;2&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AVB or asystole&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">830 &#40;5&#46;8&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">519 &#40;5&#46;7&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;307 &#40;6&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ventricular tachycardia&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">952 &#40;6&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">632 &#40;6&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;259 &#40;6&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ventricular fibrillation&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">665 &#40;4&#46;7&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">269 &#40;2&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">577 &#40;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mechanical ventilation&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">656 &#40;4&#46;6&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">440 &#40;4&#46;8&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1050 &#40;5&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stroke&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62 &#40;0&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;0&#46;3&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">109 &#40;0&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiogenic shock&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">593 &#40;4&#46;2&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">434 &#40;4&#46;7&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1339 &#40;6&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;001&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "The worldwide smoking epidemic&#46; Tobacco trade&#44; use&#44; and control&#46; Council on Scientific Affairs"
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                          "etal" => false
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                          "autores" => array:3 [
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                      "doi" => "10.1056/NEJM199403313301307"
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